The flu virus is constantly changing, with new “models” of flu appearing each year. The Center for Disease Control and Prevention (CDC) looks at the strains of influenza that have affected Australia during their flu season, and does its best to evaluate which strains are likely to be the most prevalent in the US during coming year.

The latest from the CDC has indicated that both injectable and nasal influenza vaccine will be available for prevention of influenza during the 2019-2020 season. As in years past, children with neurologic conditions should receive only injectable vaccines and should NOT receive the live virus nasal spray flu vaccine.

Vaccines available this season

• Trivalent vaccine (“Flu shot”)
  • Contains protection against 3 influenza viruses (H1N1, H3N2 and one influenza virus); this is the vaccine most often prescribed for those > 6 months of age
  • The ONLY people who should not get the flu shot are
    • Those under 6 months of age
    • Those with severe, life threatening allergies to the flu vaccine
    • If you have an egg allergy, you SHOULD receive the flu vaccine after consulting with your primary care provider
• Quadrivalent vaccine
  • Adds a second strain of influenza B
• High-Dose Flu Vaccine
  • Contains 4 times the antigen of the 3 influenza strains included in the standard flu shot; it is generally recommended for adults over 65yo
• Cell based vaccine
  • This vaccine is grown in cell culture and is not dependent on egg supply and has the potential to offer better protection to flu viruses in circulation; available for individuals >4yo
• Intradermal vaccines
  • Quadrivalent vaccine that is injected into the skin, rather than the muscle; the needle is 90% more fine than the regular flu shot needle and requires 40% less viral antigen; it is approved for adults 18-64yo; may be helpful for those that dislike needles
• Live Attenuated Influenza Vaccine (Nasal Spray Flu Vaccine)
  • Appropriate for people 2 – 49 years old; ok for siblings and parents (check with your primary care provider first), but NOT for those with dystrophinopathy, regardless of whether they are taking steroids.

Medical Management of the Flu

Antiviral medications should be started within 2 days of the beginning of the illness.  There are 3 antiviral drugs approved this season to manage the flu.

• Oseltamivir (Tamiflu^R): approved for children >2 weeks; available in pills or liquid
• Zanamivir (Relenza^R): approved for children >7 years; not recommended if there is underlying respiratory dysfunction; given via inhaler
• Baloavir (Xofluza^R): single dose pill approved for early outpatient children >12 years

The most common side effects of any antiviral drugs are nausea and vomiting; Zanamivir (because it is inhaled) may cause difficulty breathing and diarrhea.

Over the counter medications that are generally safe for colds and flu can be found here.  If you/your child has a fever over 104⁰ F that is not responding to Tylenol (going down to at least 102^o F within 1-2 hours of giving Tylenol), please ask your primary care provider and neuromuscular team if it is safe to use ibuprofen (Advil^R) and/or naproxen (Aleve^R).  Be sure that the person that you ask is aware of ALL medications that are being taken (including ACE inhibitors).

When to seek emergency care

Typical symptoms of the flu include fever, cough, sore throat, runny/stuffy nose, body aches, headache, chills and fatigue.  Occasionally symptoms may include vomiting and diarrhea.  There may also be respiratory symptoms without fever.

There are warning signs that you/your child need emergency care immediately.  These include:

In children

• Fast breathing or trouble breathing
• Bluish lips or face
• Ribs pulling in with each breath
• Chest pain
• Severe muscle pain (child refuses to walk)
• Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
• Not alert or interacting when awake
• Seizures
• Fever above 104°F
• In children less than 12 weeks, any fever
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

In adults

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest or abdomen
• Persistent dizziness, confusion, inability to arouse
• Seizures
• Not urinating
• Severe muscle pain
• Severe weakness or unsteadiness
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

We wish you a healthy flu season.  As always, if you have not already done so, get vaccinated!!!